Craft work.

Top Line: If you’re a new QuadShot reader, you may not know about ontogenetic cancer field theory.

The Study: Let us tell you. Field theory is based on the idea that cancer is a form of reverse morphagenesis (an idea coined “catagenesis”) whereby devolved cancer cells migrate primarily along embryologically defined tissue layers. It would be natural, then, to direct surgical excision along these embryological planes. The Leipzig School of Radical Pelvic Surgery has pioneered the technique of radical, ontogenetic resections for gynecologic malignancies. Here, we have their very large single-institution report of experiences with total mesometrial resection (TMMR) for localized cervical cancer. Their rationale is that the reason conventional surgery fails (and the reason radiation is needed) is that the mullerian compartment is incompletely resected in your run of the mill radical hysterectomy. Therefore, a radical ontogenetic approach obviates the need for adjuvant radiation therapy. Over 500 patients with FIGO IB1 (51%) to IIB (31%) cervical cancer were treated with TMMR and therapeutic lymph node dissection. While the procedure sounds out there, it is essentially a modified radical hysterectomy with a freakish attention to anatomic detail. That detail leads to careful development of compartmental planes to both resect the involved mullerian compartment and preserve normal tissues. At 5 years, the rate of disease-specific survival was almost 90% and recurrence-free survival was 83%—all without the addition of adjuvant radiation therapy. Toxicity was low with only 3% grade 3+ toxicity and just over 20% acute grade 2 toxicity.

TBL: Radical surgery without radiation for up to FIGO stage IIB cervical cancer results in excellent clinical outcomes... at the Leipzig School of Radical Pelvic Surgery. | Hockel, Lancet Oncol 2019